Videos 1-12: If at First You Don’t Succeed, Try, Try Again: A Stepwise Approach to the Non-Dilatable Lesion

Video 1. Total occlusion of saphenous vein graft to D2 at its proximal anastomosis status post prior BMS.

Video 2. RAO cranial angiogram of LCA demonstrating a long subtotal lesion of D2.

Video 3. LAO cranial angiogram demonstrating the severe diagonal lesion (which was notable for the absence of apparent calcification).

Video 4. Emerge compliant balloon at 16 atmospheres.

Video 5. NC Quantum Apex balloon at 24 atm.

Video 6. NC Quantum Apex at 24 atm with buddy wire in place (focused force angioplasty).

Video 7. Repeat angiography after unsuccessful attempts with balloon angioplasty demonstrating impaired distal flow.

Video 8. Advancement of excimer laser (Spectranetics) across the resistant lesion.

Video 9. After plaque modification with the excimer laser, there is full uniform expansion of NC Quantum 2.0 mm balloon at 12 atm.

Video 10. Improved flow after lasing run and NC balloon inflation.

Video 11. Result after stent placement (LAO cranial projection).

Video 12. Final result (RAO cranial projection).

From "If at First You Don’t Succeed, Try, Try Again: A Stepwise Approach to the Non-Dilatable Lesion"

Authors:

Antony G. Kaliyadan, MD, Henry Siu, MD, David L. Fischman, MD, Nicholas J. Ruggiero II, MD, Brandon M. Madsen, BS, and Michael P. Savage, MD, Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania